Drug-induced hyperthyroidism
- Authors: Ostroumova O.D.1,2, Kachan V.O3, Kochetkov A.I1
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Affiliations:
- N.I. Pirogov Russian National Research Medical University
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Samara State Medical University
- Issue: Vol 26, No 14 (2019)
- Pages: 74-81
- Section: Articles
- URL: https://journals.eco-vector.com/2073-4034/article/view/312412
- DOI: https://doi.org/10.18565/pharmateca.2019.14.74-80
- ID: 312412
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Abstract
Drug-induced hyperthyroidism (DIH) is endocrinopathy in which an excess of thyroid hormones in the body is caused by taking medications. The prevalence of DIH has not been studied generally, but the prevalence of hyperthyroidism caused by individual drugs is known. For example, the prevalence of amiodarone-induced hyperthyroidism is from 1.4 to 64%, alemtuzumab-induced hyperthyroidism is from 14.8 to 33%, lithium-induced hyperthyroidism is from 0.1 to 1.7%. The risk factors for DIH include other thyroid diseases in a case history at past or present as well as in the family history, female sex. The mechanisms of development of DIH may be different for different drugs, but the main ones are autoimmune disorders and toxic damage to thyrocytes. Most often, DIH occurs when taking alemtuzumab and some other immunosuppressants, amiodarone, tyrosine kinase inhibitors, interferons, lithium preparations, etc. During the diagnosis, thyroid-stimulating hormone, triiodothyronine and thyroxine levels are taken into account, as well as clinical symptoms and the fact of taking medications which can induce hyperthyroidism. For successful DIH therapy it is recommend canceling the drug which caused this state, but this is not always possible. We can use various combinations of β-blockers, calcium channel blockers, glucocorticosteroids, iodine preparations, thionamides (methimazole, propylthiouracil, etc.) for the treatment of DIH depending on the pathophysiological mechanism of the development of hyperthyroidism. In the case of resistance to ongoing drug therapy, thyroidectomy is possible. Recommendations to prevent DIH are: preliminary screening for the presence of thyroid pathology before starting treatment with drugs which are associated with the development of DIH; correction of thyroid dysfunction; using an adequate amount of selenium; informing patients about the possibility of developing symptoms of the disease and the need to consult a doctor for timely correction; the use of alternative treatment regimens in patients with risk factors for the development of DIH.
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About the authors
Olga D. Ostroumova
N.I. Pirogov Russian National Research Medical University; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: ostroumova.olga@mail.ru
MD, Professor, Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Clinical and Research Center of Gerontology
V. O Kachan
Samara State Medical University
A. I Kochetkov
N.I. Pirogov Russian National Research Medical University
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